Hanoi Vietnam 2007
On arrival we take a taxi to our hotel. After a flight of almost 15 hours I just need a bed. I get woken up by a phone call from Dorte Werner from the Hanoi International Women’s Club (HIWC). She asks if she can pass by at 4PM. I agree.
Dorte takes care of the work permits, has the contacts with the hospital and brings us a lunch in the operating theatre every day. Dorte is an angel.
First lunch and then to work
The next day at 8AM as agreed we’re in the Hanoi Pediatric Hospital. It’s as busy as the Amsterdam central station on a Friday afternoon. The corridors are completely stuffed with people making lines everywhere. It’s a hospital with 600 beds but has mostly around 1000 patients admitted.
First we have to meet the director. Even delivery of our instruments for sterilization is not possible before this ceremony has taken place. Finally at 1 PM, after the welcome lunch we can start to operate. We perform 4 surgeries that day.
The day starts with traffic jams.
Again at 8AM we’re in the hospital. To get there has become a lot more complicated than the year before. The traffic suffers from a kind of infarction. When we came here for the first time, 4 years ago, you hardly saw any cars, but there were a lot of
‘motorbikes’, with 4 stroke engines of about 100cc. They have around 1 million of those in Hanoi. Like ants they drive behind and through one another hooting loudly. Sometimes with 3 people sitting on top of it or someone carrying a step-ladder. But there are more and more cars and the roads absolutely cannot handle them. The city absolutely needs a subway system, for which plans have been made. But before that will be finished in 5 to 10 years the traffic will be in absolute chaos. The last couple of meters to the hospital we have to go by foot. The traffic is completely stuck. Today we operate on 10 children.
A difficult dilemma
A total of 78 children have been collected, a number that we’ll never be able to operate in one week. Most of them already have an operated lip. Now they come for closure of the palate. That’s important for good speech and to prevent food and liquids entering the nose. For this, different operating techniques have been developed. The Vietnamese doctors use the simplest one in which mucosa and muscles are mobilized from front to back and sutured in the middle. The disadvantage of this technique is that the soft palate becomes too short causing a too nasal sound during speech that is difficult to understand. Moreover the scar tissue on the hard palate will counteract growth of the upper jaw. Therefore in a young child we prefer to operate on the soft palate only. With a Z-plasty we lengthen the soft palate. The hard palate we leave open until the age of 9 – 10 years. But parents and hospital personnel in Vietnam are used to a complete closure of the palate in one operation. Short term that’s nice for the patient but long term it isn’t. We do what is best for the patient on the long term, the Z-plasty. When children are a bit older we close the whole palate in one operation but with mucosal flaps that we take from the inside of the cheeks. A long tiring operation of about 2.5 hours, but with a nice result.
After a third day of surgeries we go for a massage to treat our painful backs in a massage centre. They should have some more centers like that in the Netherlands.
On the fourth working day we operated on another 10 children. About 25% of the operations are lip corrections, primary or secondary. Primary means they haven’t been operated before. For us that’s nice because then, with a more or less standard operation, we can achieve optimal function and beauty for the lip. Some children however have been operated before and the parents are right not to be happy with the result. A lot of these surgeries are performed by doctors in the provinces that have very little knowledge of the techniques available. But also in Hanoi the results of lip surgeries performed by local doctors leave much to be desired. The reason is that local surgeons are trained with the idea that an operation most of all needs to be done fast. Anesthetics are expensive and the budget is limited, so this is understandable. Another not so easy to understand reason is the idea that a good surgeon is a fast surgeon. Aesthetics are considered not to be important, but machismo is.
We propose to Dr Hai, a surgeon with whom we’re in close contact, to publish our book about cleft lip surgery in Vietnamese as well. We intend to publish this book ‘Cleft lip surgery, a practical guide’ this year. Dr Hai says that he’s willing to make the translation. We can finance the printing with money from the foundation, so that the book can be given to Vietnamese surgeons for free.
The fact that some parents are willing to travel several days (sometimes walking) to have a second surgery of an ugly operated lip, means that for them aesthetics absolutely are important.
It’s coming to an end again
Our last surgical day, 8 operations. In total we’ve been able to help 42 children. The Vietnamese doctors (no idea who they are, we haven’t seen them) according to Dorte have also operated on 22 children. The remaining children couldn’t be operated on this time because of bad health. They will have to come back another time.
In the evening we offer a dinner at the Metropole Hotel to the director of the hospital and a couple of doctors that have been involved in the operations. It’s a Vietnamese restaurant, but the chef is French, absolutely fabulous! Such a dinner is important to keep the contacts you need to be able to return each year. We settle to come back next year in October.
My travel partners stay in Vietnam for another week and travel around. Joel will give a presentation to Vietnamese doctors about orthognatic surgery (jaw surgery) next week. I’ll fly back to the Netherlands tomorrow. Monday I’ll have outpatient care in Leerdam and in the evening I’ll fly to Marbella. There I’ll have two surgeries on Tuesday. What a life….!
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